CBD Oil

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2013anes

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Are any of you guys formally recommending CBD oil for analgesia? Any good results with patients? Any type of patient profile that seems to work well (e.g. diffuse complaints vs specific location, fibro vs. radicular)? Any real data you've stumbled across?
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The problem is the lack of great data for efficacy of CBD for pain and the inability to verify there is no THC in most of the CBD oils commercially available. It seems to help some folks, mainly the anxious, somatizers, who are chemically coping and the diffuse neuropathic pain phenotypes.

I primarily tell patients that it may help them not care about their pain, which for some of them is all they really need, but that it might make them test positive for MJ. I tell them I can't recommend it, but they are welcome to trial it on their own. It can be a pretty expensive placebo though and I worry about the pulmonary effects if they are vaping it.

I try to justify it to myself similarly to other anti-epileptics for pain as there are stronger data for CBD for epilepsy.
 
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Right, it's a sucky place and I explain my medicolegal answer is that it is illegal federally but they all ask about the "legal stuff". I'm not a lawyer, but this state explicitly permits/allows CBD oils but not MJ so I get the question a lot.
 
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There are no human trials examining CBD alone for pain. There have been a number of RCTs (placebo controlled) of oral CBD:THC that according to a 2018 Cochrane review essentially shows, for chronic neuropathic pain, a mild to moderate decrease in mean pain scores (compared to placebo), and a statistically significant increase in QOL. The review also points out 3 RCTs that showed negative results that were not published.
 
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Those unpublished studies are the best.

You have “researchers” showing their bias - postulating a hypothesis that they disprove but are too vested to admit that they were wrong. Shows their true colors.
 
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2013anes said:
Are any of you guys formally recommending CBD oil for analgesia? Any good results with patients? Any type of patient profile that seems to work well (e.g. diffuse complaints vs specific location, fibro vs. radicular)? Any real data you've stumbled across?
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No. No. And no.

Also, patients are showing up THC positive from taking this and I'm instructing them specifically not to take CBD oil because of it. Not one of them that's tested positive for it and claimed to be taking CBD oil has told me, "Doc, since I've been using CBD oil my pain is so much better. Can we stop my pain medicine now?" But I have had to stop a few people's opiates due to testing THC positive from CBD oil (so they claim).

I could be wrong, but in my opinion, CBD oil for pain is a scam and the people selling it are marketing it as a "legal marijuana-lite" to make money.
 
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emd123 said:
No. No. And no.

Also, patients are showing up THC positive from taking this and I'm instructing them specifically not to take CBD oil because of it. Not one of them that's tested positive for it and claimed to be taking CBD oil has told me, "Doc, since I've been using CBD oil my pain is so much better. Can we stop my pain medicine now?" But I have had to stop a few people's opiates due to testing THC positive from CBD oil (so they claim).

I could be wrong, but in my opinion, CBD oil for pain is a scam and the people selling it are marketing it as a "legal marijuana-lite" to make money.
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For discussion sake:

Medical Cannabis for Neuropathic Pain. - PubMed - NCBI

The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review. - PubMed - NCBI

Some reasonable evidence for neuropathic pain?
 
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Thanks. Not sure I want to sign my name to any "Affirmative Defense Certificate" if there isn't good data for it. I have a link to what is happening in VA but can't post it because I don't meet requirements to post links :yeahright:.
 
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Ducttape said:
1. Both are meta-analysis, very subject to researcher bias. Only 1 step above clinical experience.

2. That being said, the best they can come up with low strength evidence for neuropathic pain.

Poor at best conclusions.

As a contradistinction, this article NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals states there is weak evidence against cannabinoids for neuropathic pain...
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Good Point.

Here are 2 RCTs:

A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. - PubMed - NCBI

Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain

I'm looking at the literature (for the first time), and surprised at how much there is for neuropathic pain, and how little for cancer pain...was expecting more for the latter.
 
The second study deserves attention.
1. All 39 participants as required by study design were ex-cannabis users. 16 of these were current users.
2. The study was about the effect of cannabis up to 6 hours, and a one time dose
3. Recruitment was via social media, flyers, etc, so people off the street
4. These ppl were paid.
5. It is not a CBD study (of significance primarily because of the thread we are in)

So the cynic in me thinks: “so we recruit a bunch of MJ users off the street, give them 8-12 hits that they get paid for, and ask “you feeling better dude? (Almost all males, tho chronic pain seems to have more females)” I can forecast the results..
 
DEA Internal Directive Regarding the Presence of Cannabinoids in Products and Materials Made from the Cannabis Plant

DEA Internal Directive Regarding the Presence of Cannabinoids in Products and Materials Made from the Cannabis Plant
(May 22, 2018)

In 2004, the U.S. Court of Appeals for the Ninth Circuit enjoined DEA from enforcing certain regulations with respect to tetrahydrocannabinols (THC). See Hemp Industries Ass'n v. DEA, 357 F.3d 1012 (9th Cir. 2004). The government did not seek Supreme Court review of that decision. In response to various inquiries, DEA hereby issues to DEA personnel the following internal directive on how to carry out their duties in light of the Ninth Circuit's decision.

The Ninth Circuit enjoined enforcement of what is now 21 C.F.R. § 1308.11(d)(31) (drug code 7370) with respect to products that are excluded from the definition of marijuana in the Controlled Substances Act (CSA). DEA thus does not enforce that provision as to such products.

Consistent with the Ninth Circuit's decision, DEA does not enforce 21 C.F.R. § 1308.35.

Products and materials that are made from the cannabis plant and which fall outside the CSA definition of marijuana (such as sterilized seeds, oil or cake made from the seeds, and mature stalks) are not controlled under the CSA. Such products may accordingly be sold and otherwise distributed throughout the United States without restriction under the CSA or its implementing regulations. The mere presence of cannabinoids is not itself dispositive as to whether a substance is within the scope of the CSA; the dispositive question is whether the substance falls within the CSA definition of marijuana.

The Controlled Substances Import and Export Act incorporates the schedules of the CSA. See generally 21 U.S.C. §§ 951-971. Accordingly, any product that the U.S. Customs and Border Protection determines to be made from the cannabis plant but which falls outside the CSA definition of marijuana may be imported into the United States without restriction under the Controlled Substances Import and Export Act. The same considerations apply to exports of such products from the United States, provided further that it is lawful to import such products under the laws of the country of destination.

This directive does not address or alter DEA's previous statements regarding the drug code for marijuana extract and regarding resin. See Establishment of a New Drug Code for Marihuana Extract, 81 Fed. Reg. 90194 (Dec. 14, 2016); Clarification of the New Drug Code (7350) for Marijuana Extract. As DEA has previously explained, the drug code for marijuana extract extends no further than the CSA does, and it thus does not apply to materials outside the CSA definition of marijuana.
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so have at it...
 
emd123 said:
No. No. And no.

Also, patients are showing up THC positive from taking this and I'm instructing them specifically not to take CBD oil because of it. Not one of them that's tested positive for it and claimed to be taking CBD oil has told me, "Doc, since I've been using CBD oil my pain is so much better. Can we stop my pain medicine now?" But I have had to stop a few people's opiates due to testing THC positive from CBD oil (so they claim).

I could be wrong, but in my opinion, CBD oil for pain is a scam and the people selling it are marketing it as a "legal marijuana-lite" to make money.
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Did you perform a confirmation GC/MS on the patients who tested positive for THC by urine drug screen immunoassay? If they are only using Hemp derived CBD oils then confirmation GC/MS should be negative for 11-nor-THCCOOH metabolite.
 
No_Pain_No_Gain said:
Did you perform a confirmation GC/MS on the patients who tested positive for THC by urine drug screen immunoassay? If they are only using Hemp derived CBD oils then confirmation GC/MS should be negative for 11-nor-THCCOOH metabolite.
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I always do confirmations, so, yes. In fact, I only do LC/MS UDS's and SDSs. I don't even do the dipsticks, at all. They're a total waste of time and money. They're not worth the paper they're cut from.
 
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emd123 said:
I always do confirmations, so, yes. In fact, I only do LC/MS UDS's and SDSs. I don't even do the dipsticks, at all. They're a total waste of time and money. They're not worth the paper they're cut from.
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I agree. Immunoassay is a waste of time.
 
patients can have at it... but I came across this snippet of interest. patients need to be careful too.

Notes from the Field: Acute Poisonings from a Synthetic

Notes from the Field: Acute Poisonings from a Synthetic Cannabinoid Sold as Cannabidiol — Utah, 2017–2018
Weekly / May 25, 2018 / 67(20);587–588

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Roberta Z. Horth, PhD1,2; Barbara Crouch, PharmD3; B. Zane Horowitz, MD3; Amelia Prebish, MPH2; Matthew Slawson, PhD4; Jennifer McNair5; Chris Elsholz6; Stephen Gilley7; Jenny Robertson, MSPH8; Ilene Risk, MPA8; Mary Hill, MPH8; Linnea Fletcher9; Wei Hou, MPH2; Dallin Peterson, MPH2; Karlee Adams2; Dagmar Vitek, MD8; Allyn Nakashima, MD2; Angela Dunn, MD2 (View author affiliations)

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On December 8, 2017, the Utah Poison Control Center (UPCC) notified the Utah Department of Health (UDOH) of reports of emergency department visits associated with reported exposure to products labeled as CBD (cannabidiol), a nonpsychoactive compound derived from Cannabis sativa, the marijuana plant. Five patients experienced adverse reactions, including altered mental status, seizures, confusion, loss of consciousness, and hallucinations. These reactions were inconsistent with known CBD effects (1), which prompted concern for potential adulteration with a synthetic cannabinoid (2). CBD is being studied as a treatment for several health conditions* (3); however, the Food and Drug Administration has not approved any CBD product for the treatment of any condition, and the U.S. Department of Justice Drug Enforcement Administration considers CBD as a Schedule I drug.† Sale of CBD is currently illegal in Utah, although CBD is readily available online and in shops.

State and federal health and law enforcement officials established a task force on December 11 to investigate cases and identify the source product. A suspected case was defined as the occurrence after October 1, 2017, of adverse reactions inconsistent with known CBD exposures after ingestion, inhalation, or sublingual consumption of a product labeled as CBD or hemp oil. Hospitals and law enforcement agencies or persons experiencing CBD-associated reactions were asked to report any CBD-associated cases to UPCC. Concomitantly, public health investigators searched UPCC’s database and Utah’s Syndromic Surveillance system as part of CDC’s National Syndromic Surveillance Program for CBD-related events.§ UDOH interviewed patients by telephone, using a survey adapted from a synthetic cannabinoid investigation (4). Available blood and urine obtained at emergency departments and product samples obtained from patients were submitted for chemical analysis using liquid chromatography and tandem mass spectrometry at the Utah Public Health Laboratory and the Utah Department of Public Safety crime laboratory.

By the end of January 2018, suspected cases were identified in 52 persons. Nine product samples (including one unopened product purchased by investigators from a store and brand reported by a patient) were found to contain a synthetic cannabinoid, 4-cyano CUMYL-BUTINACA (4-CCB), but no CBD.¶ Eight of the tested products were branded as “Yolo CBD oil” and indicated no information about the manufacturer or ingredients. Blood samples from four of five persons were positive for 4-CCB. Press releases were distributed to media outlets December 19–21, 2017, with a warning regarding the dangers of using the counterfeit product; information with a description of the product and associated symptoms was disseminated to health care providers and law enforcement. The number of reported cases peaked during this outreach and dropped shortly thereafter. Thirty-four suspected cases were reclassified as confirmed if the person reported use of a Yolo product or laboratory testing found 4-CCB. Approximately one quarter of persons were aged <18 years, nearly three fourths had vaped the CBD product, and approximately 60% were seen at an emergency department (Table). The top three symptoms experienced were altered mental status, nausea or vomiting, and seizures or shaking. Rapid identification and a coordinated response among state and local agencies contributed to control of the outbreak. This investigation highlights the hazards of consuming unregulated products labeled as CBD. States could consider regulating products labeled as CBD and establishing surveillance systems for illness associated with products labeled as CBD to minimize the risk for recurrences of this emerging public health threat (5).

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Conflict of Interest
No conflicts of interest were reported.

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Corresponding author: Roberta Z Horth, [email protected], 801-538-9465.

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1Epidemic Intelligence Service, CDC; 2Utah Department of Health, Salt Lake City, Utah; 3Utah Poison Control Center, Salt Lake City, Utah; 4Utah Department of Health, Public Health Laboratory, Taylorsville, Utah; 5Utah Department of Public Safety, Bureau of Forensic Services, Taylorsville, Utah; 6Utah State Bureau of Investigation, Salt Lake City, Utah; 7Utah Department of Public Safety, Statewide Information and Analysis Center, Sandy, Utah; 8Salt Lake County Health Department, Salt Lake City, Utah; 9Utah County Health Department, Provo, Utah.

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* CBD is used in treating spasticity from multiple sclerosis and Dravet syndrome, a severe form of childhood epilepsy, for which it has shown efficacy.

† A Schedule I drug, defined by the U.S. Department of Justice Drug Enforcement Administration, is a drug with no currently accepted medical use and a high potential for abuse.

§ The compound 4-CCB has been identified in Europe since 2016 when samples were intercepted as synthetic cannabinoids; 4-CCB is chemically related to other indazole-based synthetic cannabinoids, known as NACA derivatives, which are found in other synthetic cannabinoid clusters reported in the United States.

¶ Search terms included CBD-associated slang and brands. Search terms excluded symptoms because they were insufficiently specific.

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References
  1. Iffland K, Grotenhermen F. An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies. Cannabis Cannabinoid Res 2017;2:139–54. CrossRef PubMed
  2. Riederer AM, Campleman SL, Carlson RG, et al. ; Toxicology Investigators Consortium. Acute poisonings from synthetic cannabinoids—50 U.S. Toxicology Investigators Consortium registry sites, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:692–5. CrossRef PubMed
  3. Devinsky O, Cross JH, Laux L, et al. ; Cannabidiol in Dravet Syndrome Study Group. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. N Engl J Med 2017;376:2011–20. CrossRef PubMed
  4. CDC. Notes from the field: severe illness associated with reported use of synthetic marijuana—Colorado, August–September 2013. MMWR Morb Mortal Wkly Rep 2013;62:1016–7. PubMed
  5. Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling accuracy of cannabidiol extracts sold online. JAMA 2017;318:1708–9. CrossRef PubMed
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TABLE. Characteristics of suspected or confirmed cases of poisoning associated with counterfeit cannabidiol products (N = 52) — Utah, 2017–2018
​

Characteristic No. (%)
Age group (yrs)
≥18 28 (53.8)
<18 15 (28.8)
Unknown 9 (17.4)
Sex
Male 31 (59.6)
Female 14 (26.9)
Unknown 7 (13.5)
County
Salt Lake 33 (63.5)
Utah 15 (28.8)
Tooele 3 (5.8)
Weber 1 (1.9)
Medical history*
Mental health treatment 10 (19.2)
Drug abuse 4 (7.7)
Seizures 1 (1.9)
Product brand
Yolo 33 (63.5)
Other 10 (19.2)
Unknown 9 (17.3)
Source of purchase
Smoke shop 34 (65.4)
Friend 8 (15.4)
Unknown 10 (19.2)
Reason for use
Recreational 35 (67.3)
Medicinal† 15 (28.8)
Other 2 (3.8)
Method of use
Vape 38 (73.1)
Sublingual 9 (17.3)
Other 2 (3.8)
Unknown 3 (5.8)
Seen at an emergency department
Yes 31 (59.6)
No or unknown 21 (40.4)
Adverse reactions*
Altered mental status 43 (82.7)
Nausea or vomiting 26 (50.0)
Seizures or shaking 19 (36.5)
Anxiety 14 (26.9)
Unconsciousness 13 (25.0)
Hallucinations 12 (23.1)
Confusion 10 (19.2)
Dizziness 8 (15.4)
Median time to reaction onset after use, minutes (IQR) 35§ (1; 1–5)
Median duration of adverse reaction, minutes (IQR) 27§ (72; 5–72)
Abbreviation: IQR = interquartile range.
* Multiple responses possible.
† Self-reported medicinal use.
§ Number for whom information was available.

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Suggested citation for this article: Horth RZ, Crouch B, Horowitz BZ, et al. Notes from the Field: Acute Poisonings from a Synthetic Cannabinoid Sold as Cannabidiol — Utah, 2017–2018. MMWR Morb Mortal Wkly Rep 2018;67:587–588. DOI: http://dx.doi.org/10.15585/mmwr.mm6720a5.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

Questions or messages regarding errors in formatting should be addressed to [email protected].
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CBD is an effective analgesic as the study shows, it helps in the treatment of 5 pain conditions. Cannabinoids inhibit the growth of cancerous, tumors. CBD has a direct impact on multiple sclerosis and the associated pain. It helps to relieve the pain in arthritis, migraine, seizures . and epilepsy.
 
Robbin said:
CBD is an effective analgesic as the study shows, it helps in the treatment of 5 pain conditions. Cannabinoids inhibit the growth of cancerous, tumors. CBD has a direct impact on multiple sclerosis and the associated pain. It helps to relieve the pain in arthritis, migraine, seizures . and epilepsy.
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yet oddly enough, we do not have evidence based medicine or true clinical research to back any of your claims....
 
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I had a number of pts on medical cannabis during fellowship, and they did reasonably well. I'm not sure why a pain physician would care if his/her pt uses it legally or illegally.
 
Because if you prescribe opioids and he is “caught” for any reason - you will bear legal responsibility.

It’s pretty obvious....
 
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You don't prescribe opiates to the pt who is using medical marijuana. If he or she is receiving "treatment" via cannabis, you don't Rx Norco. It's one or the other IMO.

Also what legal responsibility are you talking about? I'm asking bc I really don't understand that. If a pt is on Norco for 2 years and they reduce their dose by 75% bc they found a doctor who gives them a marijuana card, what is the issue? I am asking that assuming the worst case scenario - The MD continues prescribing the Norco.
 
SommeRiver said:
You don't prescribe opiates to the pt who is using medical marijuana. If he or she is receiving "treatment" via cannabis, you don't Rx Norco. It's one or the other IMO.

Also what legal responsibility are you talking about? I'm asking bc I really don't understand that. If a pt is on Norco for 2 years and they reduce their dose by 75% bc they found a doctor who gives them a marijuana card, what is the issue? I am asking that assuming the worst case scenario - The MD continues prescribing the Norco.
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Nope. You keep prescribing the Norco. DEA sees THC as schedule 1. They hold your registration. Not permissible.
 
You prescribe the Norco and then what? Tell the pt you won't see them again if they use medical marijuana in a state that where it is both recreationally and medically legal?
 
I tried some CBD oil out of curiosity. My patient ordered it online and recommended it (nurse who didn’t want to take narcotics). Nothing special happened. I don’t see how it could be abused.
 
If a pt is using medical marijuana and has a card through some other doctor, and that pt is seen by you and in the past has received Norco from you, you tell the pt it is either the cannabis or the Norco. Choose one bc you're not getting Norco if you're using marijuana. I don't have to Rx anything if I don't want to Rx it. The pts in fellowship on it weren't getting opiates from us, and it wasn't a problem.
 
SommeRiver said:
You prescribe the Norco and then what? Tell the pt you won't see them again if they use medical marijuana in a state that where it is both recreationally and medically legal?
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yes. as long as they are getting norco from you, you have to monitor use of illicit substances. if you check for thc and it is +, you have to take action. you dont have to discharge from practice tho.

if you dont check for THC, there remains the possibility you could be censured by DEA for not doing due diligence. and a not insignificant portion of CBD products contain THC as a contaminant.

this may seem confusing to you because you presume that people will choose one or the other. given the options, people will usually opt for both. but they will opt for the "legal" way first.

ie in most cases, you will be prescribing Norco and surreptitiously find out that your patient has been smoking ganga that he calls medical marijuana without a license, of stuff he buys off the street.
 
We have a simple rule in our practice about CBD oil. If what you are using comes up positive on a drug screen for THC, then in our state, it is an illegal drug. Period, end of story. I tell them, that if you want to continue receiving opioids, you must stop using it immediately and must test negative at the next screen.

I am really surprised at all the hoopla for cannabinoids for pain relief. I've read the studies and they are not definitive. If it's so good, then why do the majority of patients who smoke weed want opioids on top of it? My suspicion is that they like getting high and don't want to give that up.
 
THC is psychoacitve and gets patients high

CBD is not psychoactive and had no euphroic effects. This is because it is thought to be somewhat of an antagonist at the CB1/CB2 receptors. It affects pain through unknown mechanisms, but is possibly related to an increase in endogenous cannabinoids and anti inflammatory effects. The pre clinical studies are fairly promising, for what that's worth.

There are no clinical trials on only CBD I think because it is thought that THC or a combo of CBD:THC would be more effective. Obviously you want to give your big expensive clinical trial the maximum opportunity to succeed. These studies though, many patients drop out because they can't tolerate the psychoactive side effects of THC. You are also limited in the doses you can give 2/2 side effects

What we need is a phase 1/2 trial looking at dose escalation of pure oral CBD. The doses used in the animal studies that have been promising are much higher than with anything that has been tried in humans.
 
Ducttape said:
yes. as long as they are getting norco from you, you have to monitor use of illicit substances. if you check for thc and it is +, you have to take action. you dont have to discharge from practice tho.

if you dont check for THC, there remains the possibility you could be censured by DEA for not doing due diligence. and a not insignificant portion of CBD products contain THC as a contaminant.

this may seem confusing to you because you presume that people will choose one or the other. given the options, people will usually opt for both. but they will opt for the "legal" way first.

ie in most cases, you will be prescribing Norco and surreptitiously find out that your patient has been smoking ganga that he calls medical marijuana without a license, of stuff he buys off the street.
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If a pt is using marijuana you stop giving them opiates. I don't think anyone would disagree with that, but that's simply based on legal issues rather than medical risk. Stopping the prescribing of opiates is my taking action but that's it. I'm obviously talking about ppl with medical cards and not ppl buying pot off the street.
 
This will certainly be a disrupter. How many that only want CBD oil for my pain and not to get high want a prescription?

Cannabis-based drug for epilepsy worries some parents

A British pharmaceutical company is getting closer to a decision on whether the U.S government will approve the first prescription drug derived from the marijuana plant, but parents who for years have used cannabis to treat severe forms of epilepsy in their children are feeling more cautious than celebratory.

The U.S. Food and Drug Administration is expected to decide by the end of the month whether to approve GW Pharmaceuticals’ Epidiolex. It’s a purified form of cannabidiol — a component of cannabis that doesn’t get users high — to treat Dravet and Lennox-Gastaut syndromes in kids. Both forms of epilepsy are rare.
 
Pure CBD oil is pretty benign. I personally don't take stock in it but if the patient is willing to spend their money it, who am I to stop them.

Marijuana or anything with THC I treat just as stringent as opioids. Pick one or the other, can't be on both and continue to be seen in the clinic.
 
CBD is dangerous because it is being touted by those selling it to cure cancer, skin diseases, hypertension, anxiety/depression, and many other maladies. Patients are stopping their prescription drugs because the CBD sellers give anecdotes on their website about all its miraculous effects resulting in the cessation of all medications. People also vape CBD, with carrier oils hemp and coconut having unknown effects in the lungs. The industry is out of control and in some cases, there is absolutely no CBD in the bottles being sold. It is a giant scam industry at the moment.
 
Hi there,
I want to buy a CBD vape pen for my brother. He told me that wanted to have one, so I've decided to make him a present for his Birthday.
However, I'm not keen on these things. Trying to find something on the Internet. But too many information. Of course, all of them want to sell as more as possible. So I've decided to read reviews, not descriptions on selling sites.
Reading on VapingDaily about different CBD vape oils. Had no idea that there are so many of them.
Don't know which one to choose. Is there someone who can help? Maybe someone uses one?
Would be grateful for the help.
 
Marry23456 said:
Hi there,
I want to buy a CBD vape pen for my brother. He told me that wanted to have one, so I've decided to make him a present for his Birthday.
However, I'm not keen on these things. Trying to find something on the Internet. But too many information. Of course, all of them want to sell as more as possible. So I've decided to read reviews, not descriptions on selling sites.
Reading on VapingDaily about different CBD vape oils. Had no idea that there are so many of them.
Don't know which one to choose. Is there someone who can help? Maybe someone uses one?
Would be grateful for the help.
Click to expand...
LMAO
 
Marry23456 said:
Hi there,
I want to buy a CBD vape pen for my brother. He told me that wanted to have one, so I've decided to make him a present for his Birthday.
However, I'm not keen on these things. Trying to find something on the Internet. But too many information. Of course, all of them want to sell as more as possible. So I've decided to read reviews, not descriptions on selling sites.
Reading on VapingDaily about different CBD vape oils. Had no idea that there are so many of them.
Don't know which one to choose. Is there someone who can help? Maybe someone uses one?
Would be grateful for the help.
Click to expand...
The blue one.
 
Marry23456 said:
Hi there,
I want to buy a CBD vape pen for my brother. He told me that wanted to have one, so I've decided to make him a present for his Birthday.
However, I'm not keen on these things. Trying to find something on the Internet. But too many information. Of course, all of them want to sell as more as possible. So I've decided to read reviews, not descriptions on selling sites.
Reading on VapingDaily about different CBD vape oils. Had no idea that there are so many of them.
Don't know which one to choose. Is there someone who can help? Maybe someone uses one?
Would be grateful for the help.
Click to expand...
I would recommend you to go with Nuleaf naturals or cbdistillery. These 2 are the best brands on CBD I've ever come across. Just make sure it's legal in your state ;)
 
There are no "best brands" of CBD- it is an uncontrolled chemical manufacturing industry- CBD does not exist in nature, but CBD-A does. The conversion to CBD is production of a chemical, frequently each lot remains without analysis of lead (concentrated in hemp plants) or content of CBD and other cannabinoids. The labs doing the analysis are not national labs and may be owned by the garage manufacturers of CBD.
 
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Tomasson said:
Yes, I can safely recommend using CBD oil as a pain reliever. It is great for various pains, sleep problems, and anxiety. Regarding side effects in healthy people - nothing serious, dry mouth is possible. But it should be borne in mind that diabetics need to use it very carefully, as various side effects may occur. Alternatively, they can replace CBD oil with kratom. I think it will also be a very effective replacement. Unfortunately, I don’t get my hands on it to check for sure. I have already even found a site from which I will order http://kratomgallery.com/, but unfortunately I have no free time for this project. I would be glad if someone would share their research on this matter. Thanks in advance!
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Kratom! Ha!
 
Tomasson said:
Yes, I can safely recommend using CBD oil as a pain reliever. It is great for various pains, sleep problems, and anxiety. Regarding side effects in healthy people - nothing serious, dry mouth is possible. But it should be borne in mind that diabetics need to use it very carefully, as various side effects may occur. Alternatively, they can replace CBD oil with kratom. I think it will also be a very effective replacement. Unfortunately, I don’t get my hands on it to check for sure. I have already even found a site from which I will order http://kratomgallery.com/, but unfortunately I have no free time for this project. I would be glad if someone would share their research on this matter. Thanks in advance!
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Dear Sir/Madam,

I represent the family of a Prince in exile from Nigeria. We are wondering if you would assist us in the recovery of the sum of 8,000,000 USD from the First National Bank of Nigeria. As reward for your service, you would be entitled to half of this amount.

Please contact me at your earliest convenience.

With gratitude,

Warren Buffett
 
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